Medical Management of Vaccine Reactions in Adults

in a Community Setting
Administering any medication, including vaccines, they can vary from minor (e.g., soreness, itching)
The table below has the potential to cause an adverse reaction. to the rare and serious (e.g., anaphylaxis). Be
describes steps To minimize the likelihood of an adverse event, prepared.
to take if an screen patients for vaccine contraindications Vaccine providers should know how to rec-
adverse reaction and precautions prior to vaccination (see “Screen- ognize allergic reactions, including anaphylaxis.
occurs following ing Checklist for Contraindications to Vaccines Have a plan in place and supplies available
vaccination. for Adults” at www.immunize.org/catg.d/ to provide appropriate medical care should such
p4065.pdf). When adverse reactions do occur, an event occur.

reaction signs and symptoms management

Localized Soreness, redness, itching, or swelling at the Apply a cold compress to the injection site.
injection site Consider giving an analgesic (pain reliever) or
antipruritic (anti-itch) medication.

Slight bleeding Apply pressure and an adhesive compress over

the injection site.
Continuous bleeding Place thick layer of gauze pads over site and
maintain direct and firm pressure; raise the bleed-
ing injection site (e.g., arm) above the level of
the patient’s heart.

Psychological Fright before injection is given Have patient sit or lie down for the vaccination.
fright,
presyncope, Patient feels “faint” (e.g., light-headed, dizzy, Have patient lie flat. Loosen any tight cloth­ing
and syncope weak, nauseated, or has visual disturbance) and maintain open airway. Apply cool, damp
(fainting) cloth to patient’s face and neck. Keep them under
close observation until full recovery.

Fall, without loss of consciousness Examine the patient to determine if injury is

present before attempting to move the patient.
Place patient flat on back with feet elevated.
Loss of consciousness Check to determine if injury is present before
attempting to move the patient. Place patient flat
on back with feet elevated. Call 911 if patient
does not recover immediately.

Anaphylaxis Skin and mucosal symptoms such as general- See the emergency medical protocol on the
ized hives, itching, or flushing; swelling of lips, next page for detailed steps to follow in treating
face, throat, or eyes. Respiratory symptoms anaphylaxis.
such as nasal congestion, change in voice,
sensation of throat closing, stridor, shortness
of breath, wheeze, or cough. Gastrointestinal
symptoms such as nausea, vomiting, diarrhea,
cramping abdominal pain. Cardiovascular
symptoms such as collapse, dizziness, tachy-
cardia, hypotension.
continued on next page �

Immunization Action Coalition Saint Paul, Minnesota • 651- 647- 9009 • www.immunize.org • www.vaccineinformation.org
www.immunize.org/catg.d/p3082.pdf • Item #P3082 (7/19)
 Medical Management of Vaccine Reactions in Adults in a Community Setting (continued) page 2 of 2

Emergency medical protocol for management of anaphylactic

Suggested Medications for Managing reactions in adults in a community setting
Anaphylaxis in a Community
1 If itching and swelling are confined to the injection site where the vaccination
Immunization Clinic Setting
was given, observe patient closely for the development of generalized symptoms.
first-line medication
Epinephrine 1.0 mg/mL aqueous solution
2 If symptoms are generalized, activate the emergency medical system (EMS;
(1:1000 dilution) in prefilled autoinjector or e.g., call 911) and notify the patient’s physician. This should be done by a
prefilled syringe (0.3 mg), prepackaged second person, while the primary healthcare professional assesses the airway,
syringes, vials, or ampules. At least three breathing, circulation, and level of consciousness of the patient. Vital signs
epinephrine doses should be available onsite. should be monitored continuously.
optional medications: H1 antihistamines
These relieve itching and hives only; they
3 drug dosing information: The first-line and most important therapy in
DO NOT relieve upper or lower airway anaphylaxis is epinephrine. There are NO absolute contraindications to epineph-
obstruction, hypotension, or shock. rine in the setting of anaphylaxis.
Diphenhydramine (e.g., Benadryl) oral, a First-line treatment: Epinephrine is the first-line treatment for anaphylaxis,
12.5 mg/5 mL liquid, 25 or 50 mg tablets and there is no known equivalent substitute. Use epinephrine in a 1.0 mg/mL
Additional emergency supplies aqueous solution (1:1000 dilution). Administer a 0.3 mg dose IM using a
you may need premeasured or prefilled syringe or an autoinjector in the mid-outer thigh.
Syringes (1 and 3 cc) and needles (22 and If using another epinephrine formulation, the recommended dose is 0.01 mg/kg,
25 g, 1”, 1½”, and 2”) if needed for epi- ranging for adults from 0.3 mg to maximum dose of 0.5 mg. Administer IM,
nephrine
preferably in the mid-outer thigh. Epinephrine dose may be repeated 2 addi-
Alcohol wipes tional times every 5–15 minutes (or sooner as needed) while waiting for EMS
Tourniquet to arrive.
Applied on the extremity above the injection site to
slow systemic absorption of antigen and anaphylactic
mediators
b Optional treatment: H1 antihistamines relieve itching and urticaria (hives).
These medications DO NOT relieve upper or lower airway obstruction, hypo-
Stethoscope
tension, or shock. Consider giving diphenhydramine (e.g., Benadryl) for relief
Blood pressure measuring device with
of itching and hives. Administer orally 1–2 mg/kg every 4–6 hours, up to a
adult-sized and extra-large cuffs
maximum single dose of 100 mg.*
Tongue depressors
Light with extra batteries (for exam­ination 4 Monitor the patient closely until EMS arrives. Perform cardiopulmonary resusci-
of the mouth and throat) tation (CPR), if necessary, and maintain airway. Keep patient in recumbent posi-
A timing device, such as wristwatch, for tion (flat on back) unless he or she is having breathing difficulty. If breathing is
checking pulse difficult, patient’s head may be elevated, provided blood pressure is adequate
Cell phone or access to onsite phone to prevent loss of consciousness. If blood pressure is low, elevate legs. Monitor
blood pressure and pulse every 5 minutes.
For remote areas without EMS support
Adult airways (various sizes) 5 Record the patient’s reaction (e.g., hives, anaphylaxis) to the vaccine, all vital
Adult-sized pocket mask with one-way valve
signs, medications administered to the patient, including the time, dosage,
response, and the name of the medical personnel who administered the medi-
Oxygen (if available)
cation, and other relevant clinical information.
6 Notify the patient’s primary care physician.
7 Report the incident to the Vaccine Adverse Event Reporting System (VAERS) at
references www.vaers.hhs.gov.
* American Academy of Pediatrics. Red Book: 2018–
2021, 31st ed (p. 66).
Campbell RL, Kelso JM. Anaphylaxis: Emergency
treatment. In: UpToDate, Post TW (Ed), UpToDate,
These standing orders for the medical management of vaccine
Waltham, MA. November 2018.
reactions in adult patients shall remain in effect for patients of the
Kroger AT, Duchin J, Vazquez M. General Best
Practice Guidelines for Immunization. Best Practices until rescinded or until
name of clinic date
Guidance of the Advisory Committee on Immuni-
zation Practices (ACIP) at www.cdc.gov/vaccines/
hcp/acip-recs/general-recs/index.html. medical director’s signature date of signing

Immunization Action Coalition • Saint Paul, Minnesota • 651- 647- 9009 • www.immunize.org • www.vaccineinformation.org
www.immunize.org/catg.d/p3082.pdf • Item #P3082 (7/19)